Mr. Addo, a sixty four year old man who loves to play tennis, has had right knee pain for 3 years. He does not complain of any other joint pains except for two of his left fingers. He has noticed stiffness in the knee in the morning and hears crackling sounds when he moves the joint. There is no swelling or warmth of the knee. After some laboratory tests were done all results were normal. X-rays indicated that Mr. Addo has OSTEOARTHRITIS.
As we age, we experience all kinds of pain, ranging from waist pain, hip to knee pain, including pain in the fingers and toes. I’m sure most of the elderly have heard the word arthritis being mentioned when complaint of such pain is made. In this edition, we will look at osteoarthritis, what it is? Its causes and treatment options.
Osteoarthritis (OA) is the most common joint disorder. It is a normal result of aging, caused by ‘wear and tear’ on a joint. It is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints and allows bones to glide over one another.
Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or degenerative joint disease (DJD).
Osteoarthritis occurs more frequently as we age. Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.
Often, the cause of OA is unknown however it is mainly related to aging. Osteoarthritis is usually referred to as primary osteoarthritis when the cause is unknown, thus it is as a result of natural ageing of the joint. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. Thus it is caused by another disease or condition. The following are some of such conditions:
- Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary basis for this condition.
- Obesity causes osteoarthritis by increasing the mechanical stress on the joint and therefore on the cartilage. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight.
- Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players and army military personnel. Interestingly, studies have not found an increased risk of osteoarthritis in long-distance runners.
- Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudo gout.
- Congenital abnormalities: Some people are born with abnormally formed joints that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.
- Hormonal disturbances: Diabetes and growth hormone disorders are also associated with early cartilage wear and secondary osteoarthritis.
The symptoms of OA usually appear at middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.
If the cartilage breaks down and wears away, the bones rub together.
This causes pain, swelling, and stiffness.
Bony spurs or extra bone may form around the joint, seen on an x-ray.
The ligaments and muscles around the joint become weaker and stiffer.
Crackling sounds in the joint.
Difficulty in movement of the joint.
When you present the above symptoms to the doctor he will do a physical exam on the joint in question and in turn do some tests to confirm the diagnosis.
- These include blood tests to rule out all other conditions that could contribute to degeneration of cartilage.
- A plain x-ray of the affected joint.
- Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan may be needed if the x-ray does not give enough detail.
There is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. The goal of treatment is to reduce joint pain and inflammation while improving and maintaining joint function.
Where the pain is bearable the patient will not need treatment. Other patients may benefit from conservative measures such as rest, exercise, diet control with weight reduction, physical therapy and/or occupational therapy, and mechanical support devices, such as knee braces for knee degeneration. These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees.
Medications are used to complement the physical measures described above. Medication may be used topically, taken orally, or injected into the joints to decrease joint inflammation and pain. When conservative measures fail to control pain and improve joint function, surgery can be considered. Total hip and total knee replacements are now commonly performed in teaching and private hospitals, such as the Korle-Bu Teaching hospital, 37 Military Hospital and the FOCOS Orthopaedic Hospital, in Accra. These can bring dramatic pain relief and improved function to a person who gains no relief from pain medication.
Speak to your doctor about these treatment options once you are diagnosed of osteoarthritis, and together with your doctor, choose what works best for you.
Theresa Aaban Yirerong,
SRN,SNO, Public Health Specialist(MPH)
Occupational Health, Safety and Environmental Officer.
Foundation for Orthopaedics and Complex Spine
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